Song Yun, Chen Eunise, Chiang Yi-Ju, Yao James C, Halperin Daniel M, Chatterjee Deyali, Badgwell Brian D
Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Surg Oncol. 2025 Feb;131(2):204-211. doi: 10.1002/jso.27876. Epub 2024 Sep 10.
Not all gastric neuroendocrine tumors (GNETs) may be classified into one of the three described clinicopathologic subtypes. The purpose of this study was to better characterize GNET subtypes and associated outcomes.
Patients treated for GNET at our institution (1995-2021) were identified. Pathologic specimens of tumors that could not be classified as type 1, 2, or 3 were further reviewed. GNETs were categorized as proton pump inhibitor (PPI)-associated based on changes in the background gastric mucosa consistent with PPI use. Distant metastasis at presentation (DM) and disease-specific survival (DSS) were evaluated.
Among 246 patients, there were 164 (67%) type 1, 5 (2%) type 2, 52 (21%) type 3, and 18 (7%) PPI-associated GNETs. Seven (3%) tumors remained unclassified. DM was more frequent with type 3 GNETs (38%) than type 1 (1%), type 2 (20%), or PPI-associated tumors (11%, p < 0.001). Ten-year DSS rates were 100% for type 1, 53% (95% confidence interval [CI], 38%-75%) for type 3, and 80% (95% CI, 58%-100%) for PPI-associated tumors (p < 0.001). GNET subtype, race, and DM were independently associated with DSS.
PPI-associated tumors may represent a distinct GNET subtype with intermediate outcomes. Other factors should also be considered in overall prognosis.
并非所有胃神经内分泌肿瘤（GNETs）都可归类为已描述的三种临床病理亚型之一。本研究的目的是更好地描述GNET亚型及其相关预后。
确定在我们机构（1995 - 2021年）接受GNET治疗的患者。对无法分类为1型、2型或3型的肿瘤病理标本进行进一步复查。根据与质子泵抑制剂（PPI）使用一致的背景胃黏膜变化，将GNETs归类为PPI相关型。评估就诊时的远处转移（DM）和疾病特异性生存（DSS）情况。
246例患者中，有164例（67%）为1型，5例（2%）为2型，52例（21%）为3型，18例（7%）为PPI相关型GNETs。7例（3%）肿瘤仍未分类。3型GNETs的DM发生率（38%）高于1型（1%）、2型（20%）或PPI相关型肿瘤（11%，p < 0.001）。1型的10年DSS率为100%，3型为53%（95%置信区间[CI]，38% - 75%），PPI相关型肿瘤为80%（95% CI，58% - 100%）（p < 0.001）。GNET亚型、种族和DM与DSS独立相关。
PPI相关型肿瘤可能代表一种具有中等预后的独特GNET亚型。在总体预后中还应考虑其他因素。
